Yesterday was a good day for proponents of national health care reform, as the voices of reason were back in the air.
Senator Chris Dodd (D-CT) gave an impassioned and articulate defense of the Senate Bill that has come out of the Health, Education, Labor, and Pensions (HELP) Committee. The House Progressive Caucus announced a list of over 50 members who insist that any reform bill must have a robust public option to gain their vote. Rep. Anthony Weiner (D-NY) introduced a bill, tongue in cheek, to do away with Medicare in the House Energy & Commerce Committee. Surprisingly, given their vocal opposition to “government-run health care,” not a single Republican supported it. And finally, the Blue Dog Democrats seem ever so gradually to be climbing aboard the inevitable train of progress.
Knowing that fear is more powerful than hope, opponents of reform have ratcheted up the scare tactics. Rep. Virginia Foxx (R-NC) stated on the floor of the House that the government would order the end of life for seniors. Commercials have started running with the claim that reform will finance Planned Parenthood abortions but deny needed surgery (Not true – none of the bills deals with abortion, and only private insurance companies find ways to deny necessary surgery). And, to hear opponents tell it, a public option that competes with private insurers, with their multimillion dollar executive compensations, 40% administrative costs, and bonuses to employees who find new reasons to deny claims, will end democracy as we know it.
If there was bad news yesterday, it was the announcement by Senator Max Baucus (D-MT) that his Finance Committee will not be able to report out its version of the bill before the August break. While that does give opponents a chance to hammer away at selected provisions of the bills that aren’t yet ready to be voted on in Congress, it also gives us a chance to counter the lies and distortions being put out by the health insurance industry and the elected officials being lobbied to the tune of $1.4 million a day.
Suggested talking points for August include the following:
IF a senior tells you they fear government-financed health care, ask them if they are ready to turn in their Medicare card for the 800 number of a private insurer.
IF a veteran tells you they don’t trust the intrusion of government into their health care, ask them if they’re ready to give up their veterans’ health insurance.
IF a business man or woman tells you they think the government is unfair competition for their private health insurer, ask them when it became government’s responsibility to ensure a multimillion dollar compensation package for their private insurer’s CEO.
IF someone argues that public financing of health care will cost jobs, ask them if they know how much market share American auto manufacturers have lost to European and Asian companies that make cars without the need to pay health care for their employees because their countries have public health care plans.
IF your pro-labor friend (which many of us are) insists that employer-provided plans make public options unnecessary, ask them what they’ll do for health insurance if they lose their job.
IF anyone claims that we have the best health care in the world, ask them why we rank so low in infant mortality and have life expectancies far below the best in the world.
IF a libertarian friend tells you the government should stay out of health care, ask them why they don’t hire their own police force and fire department.
IF anyone argues that private enterprise can do a better job than the government in any endeavor, ask them if they want Blackwater and KBR taking over the defense of the nation.
Friday, July 31, 2009
Wednesday, July 29, 2009
Where are our voices?
Yesterday I watched C-SPAN as long as I could stand it (30 min) while 20 opponents gave one 1-min speech after another on the House floor in opposition to health care reform. During that stretch, only two proponents took the floor to offer a counter view.
The opponents told lies (“Reform is another word for government takeover”). They distorted the facts (“Medical care will be rationed”). They mischaracterized the plan (“Obamacare is socialized medicine”). They even tried to sow fear (“The government will kill seniors”)!
Meanwhile, the voices of our Representatives were nowhere to be heard. Perhaps they were back in their offices, trying to strike a deal that will bring the bill to the floor for a vote without gutting everything about it that would bring true reform. Or maybe they’re so confident that the battle for health care reform that’s been waged since Teddy Roosevelt first proposed it a century ago is a done deal, that they don’t need to counter the lies, distortions, and fear-mongering from the opposition. Whatever their explanation, it better be good and it better be right.
The vast majority of the American people who want health care reform now, including the right to a public option, may not be that forgiving at the polls next year – even of our current allies, if others more committed to the fight come along.
The opponents told lies (“Reform is another word for government takeover”). They distorted the facts (“Medical care will be rationed”). They mischaracterized the plan (“Obamacare is socialized medicine”). They even tried to sow fear (“The government will kill seniors”)!
Meanwhile, the voices of our Representatives were nowhere to be heard. Perhaps they were back in their offices, trying to strike a deal that will bring the bill to the floor for a vote without gutting everything about it that would bring true reform. Or maybe they’re so confident that the battle for health care reform that’s been waged since Teddy Roosevelt first proposed it a century ago is a done deal, that they don’t need to counter the lies, distortions, and fear-mongering from the opposition. Whatever their explanation, it better be good and it better be right.
The vast majority of the American people who want health care reform now, including the right to a public option, may not be that forgiving at the polls next year – even of our current allies, if others more committed to the fight come along.
Monday, July 27, 2009
The Truth About Canadian Health Care
One of the great frustrations that those of us who believe that citizens of the United States desperately need and fully deserve Health Care Reform frequently encounter is the argument by opponents that the Canadian system is dysfunctional and amounts to socialized medicine. Now American citizens who live in Canada and have experienced both systems are fighting back. A group calling for the Democrats Abroad Canada (DAC) action plan makes the following points:
BENEFITS OF CANADIAN HEALTH CARE SYSTEM
It’s less expensive: It’s well known that Canada spends less of its budget on health care than the U. S. does, but anti single-payer propaganda says that Canadians pay more taxes. What they leave out is the chunk of money Americans pay to their insurance companies. If you add that amount to taxes you would find that, in sum, Canadians pay less.
No bureaucracy gets between you and your doctor: Despite propaganda from U.S. insurance companies, the Canadian system does not force patients to go through the government to get to their doctor. In fact, it’s pretty old-fashioned: you choose a doctor and make an appointment, show your health insurance card, and that’s it. If your doctor thinks you need to see a specialist or get further tests, he/she does not have to consult an insurance bureaucrat. If your specialist thinks you need an operation, you get it – without a stack of forms to fill out.
It’s user-friendly. Unlike the U.S. system, you don’t have to fear that an illness will strike you or a loved one and lead you into bankruptcy. You don’t have to master the minutiae of co-pays and all of the methods the insurance companies use to outsmart their clients. Just that lack of stress is a health benefit in itself.
Employers: The pro-insurance propaganda says that most people get health care through their employers. What about the people who lose their jobs, or are afraid to quit and try something else? They live in fear. Also, it is often said that small businesses provide the largest percentage of jobs in America. Many simply cannot afford health care for their employees.
Proof that the Canadian system works: Since l966, when national health care was voted in – strongly opposed by the Canadian Medical Association - it has been considered one of the most important benefits of living in Canada. “Don’t mess with health care” is a message that Canadian politicians have been getting for over 40 years. Any candidate for national office who wants a U.S.-style system would lose - no doubt about it. This is not to say that there’s no room for improvement – even in the best of systems, there’s room for refinement. And when a system is under-funded or mismanaged, it’s not going to work as well as it was meant to.
BENEFITS OF CANADIAN HEALTH CARE SYSTEM
It’s less expensive: It’s well known that Canada spends less of its budget on health care than the U. S. does, but anti single-payer propaganda says that Canadians pay more taxes. What they leave out is the chunk of money Americans pay to their insurance companies. If you add that amount to taxes you would find that, in sum, Canadians pay less.
No bureaucracy gets between you and your doctor: Despite propaganda from U.S. insurance companies, the Canadian system does not force patients to go through the government to get to their doctor. In fact, it’s pretty old-fashioned: you choose a doctor and make an appointment, show your health insurance card, and that’s it. If your doctor thinks you need to see a specialist or get further tests, he/she does not have to consult an insurance bureaucrat. If your specialist thinks you need an operation, you get it – without a stack of forms to fill out.
It’s user-friendly. Unlike the U.S. system, you don’t have to fear that an illness will strike you or a loved one and lead you into bankruptcy. You don’t have to master the minutiae of co-pays and all of the methods the insurance companies use to outsmart their clients. Just that lack of stress is a health benefit in itself.
Employers: The pro-insurance propaganda says that most people get health care through their employers. What about the people who lose their jobs, or are afraid to quit and try something else? They live in fear. Also, it is often said that small businesses provide the largest percentage of jobs in America. Many simply cannot afford health care for their employees.
Proof that the Canadian system works: Since l966, when national health care was voted in – strongly opposed by the Canadian Medical Association - it has been considered one of the most important benefits of living in Canada. “Don’t mess with health care” is a message that Canadian politicians have been getting for over 40 years. Any candidate for national office who wants a U.S.-style system would lose - no doubt about it. This is not to say that there’s no room for improvement – even in the best of systems, there’s room for refinement. And when a system is under-funded or mismanaged, it’s not going to work as well as it was meant to.
Friday, July 24, 2009
Health Care Reformers Take Heart
Now is not the time for the faint of heart in the drive for health care reform.
While Senate Majority Leader Harry Reid has declared that a bill will not come out of the senate before the August break, the polls appear to show that public support for reform is waning, and the Republicans are openly calling for defeat of any effort at reform, the majority of Americans who need and want a workable health care system they can afford could be excused if they feel discouraged. But that would be reading the wrong signs in the status of the current debate.
The fundamental fact remains that Congress is in agreement on the broad principles of the Obama plan: expand coverage, control costs, preserve choice.
Delaying Senate action till September is not all bad. It simply means that Finance Committee Chairman Max Baucus (D-MT) needs more time to win support within his committee for a means of financing a reform bill that can pass the Senate. The Finance Committee bill is the key to the whole ball game, as agreement has essentially been reached on the Tri-Committee Bill from the House, and the Health, Education, Labor, and Pensions (HELP) Bill in the Senate has been voted out.
The lack of a final version of the reform package is the reason that public opinion polls appear to show slippage in support. It’s not because the public doesn’t want reform; it’s that the people are confused and frustrated at the lack of specifics. Once the details are voted out by all the committees, then reconciled between the House and Senate, advocates of reform (the majority of the American people) can galvanize around a unitary positive action for Congress to take, in contrast to all the scare tactics the opponents of reform will throw at it.
Democrats have the votes to pass a bill for the President to sign. That’s actually the unstated concession behind the Republican strategy of Just Saying No – they admit they’re going to lose in the long run. If Baucus can win over just a couple of Republicans, the bill can pass without having to break a filibuster. If he can’t, Democrats will simply have to summon the guts to force the Republicans to make good on their filibuster threat. Every poll shows that under that scenario, the American public would blame the Republicans for blocking the health care reform the country desperately needs, and the GOP can ill afford to lose even more seats in 2010.
As Obama has often said, if it were easy it would have been done by now. But it will be done. Now is the time for advocates of reform to dig down deep and keep climbing the hill toward the goals that everyone says they support: expanded coverage, lower costs, and preservation of choice. Who really wants to vote against that?
While Senate Majority Leader Harry Reid has declared that a bill will not come out of the senate before the August break, the polls appear to show that public support for reform is waning, and the Republicans are openly calling for defeat of any effort at reform, the majority of Americans who need and want a workable health care system they can afford could be excused if they feel discouraged. But that would be reading the wrong signs in the status of the current debate.
The fundamental fact remains that Congress is in agreement on the broad principles of the Obama plan: expand coverage, control costs, preserve choice.
Delaying Senate action till September is not all bad. It simply means that Finance Committee Chairman Max Baucus (D-MT) needs more time to win support within his committee for a means of financing a reform bill that can pass the Senate. The Finance Committee bill is the key to the whole ball game, as agreement has essentially been reached on the Tri-Committee Bill from the House, and the Health, Education, Labor, and Pensions (HELP) Bill in the Senate has been voted out.
The lack of a final version of the reform package is the reason that public opinion polls appear to show slippage in support. It’s not because the public doesn’t want reform; it’s that the people are confused and frustrated at the lack of specifics. Once the details are voted out by all the committees, then reconciled between the House and Senate, advocates of reform (the majority of the American people) can galvanize around a unitary positive action for Congress to take, in contrast to all the scare tactics the opponents of reform will throw at it.
Democrats have the votes to pass a bill for the President to sign. That’s actually the unstated concession behind the Republican strategy of Just Saying No – they admit they’re going to lose in the long run. If Baucus can win over just a couple of Republicans, the bill can pass without having to break a filibuster. If he can’t, Democrats will simply have to summon the guts to force the Republicans to make good on their filibuster threat. Every poll shows that under that scenario, the American public would blame the Republicans for blocking the health care reform the country desperately needs, and the GOP can ill afford to lose even more seats in 2010.
As Obama has often said, if it were easy it would have been done by now. But it will be done. Now is the time for advocates of reform to dig down deep and keep climbing the hill toward the goals that everyone says they support: expanded coverage, lower costs, and preservation of choice. Who really wants to vote against that?
Monday, July 20, 2009
No Need for Alarm: Mayo Critique of Public Plan Makes Valid Points
Now that a consortium of efficient health care providers, like the Mayo Clinic, cited frequently by proponents of health care reform as a model for the future, have written a letter critical of the House Tri-Committee plan for reform, proponents may feel a sense of alarm that a valued potential ally is deserting the fight. Alarm is not really warranted, though, for two reasons.
In the first place, a careful reading of the letter reveals opposition, not to the public option per se, but to “a public option with rates based on medicare” (my italics). This is a valid concern; medicare reimbursement rates will probably be unsustainable if a medicare-like public provider becomes the leading payer, as many of us would like to see. That is why cutting reimbursement rates instead of increasing revenue through taxation or other means is a weakness of the current measures before Congress. But it shouldn’t be considered a fatal flaw.
In the second place, the other two criticisms – one objecting to the huge geographical disparities in medicare reimbursement rates, and the second citing insufficient rewards for the quality as opposed to the quantity of health care – are also valid.
This critique by potential allies in the quest to reform health care may be seized upon by opponents of reform. Progressives can’t let those opponents use these valid points as ammunition against reform. Rather, this is an opportunity for those of us committed to reform, to join with the Blue Dog Democrats and conservatives in their call for greater emphasis on cost controls, to support the medical community in seeking more realistic and equitable reimbursement levels, and to support the effective providers, like the Mayo Clinic and Intermountain Health, in their call for legislation that rewards quality more than quantity.
First, the bills have to be voted out by both the House and the Senate, then get sent to conference, where the tweaking and fixes can best take place. In the meantime, we can’t let opponents get away with mischaracterizing some valid criticisms of the pending legislation.
In the first place, a careful reading of the letter reveals opposition, not to the public option per se, but to “a public option with rates based on medicare” (my italics). This is a valid concern; medicare reimbursement rates will probably be unsustainable if a medicare-like public provider becomes the leading payer, as many of us would like to see. That is why cutting reimbursement rates instead of increasing revenue through taxation or other means is a weakness of the current measures before Congress. But it shouldn’t be considered a fatal flaw.
In the second place, the other two criticisms – one objecting to the huge geographical disparities in medicare reimbursement rates, and the second citing insufficient rewards for the quality as opposed to the quantity of health care – are also valid.
This critique by potential allies in the quest to reform health care may be seized upon by opponents of reform. Progressives can’t let those opponents use these valid points as ammunition against reform. Rather, this is an opportunity for those of us committed to reform, to join with the Blue Dog Democrats and conservatives in their call for greater emphasis on cost controls, to support the medical community in seeking more realistic and equitable reimbursement levels, and to support the effective providers, like the Mayo Clinic and Intermountain Health, in their call for legislation that rewards quality more than quantity.
First, the bills have to be voted out by both the House and the Senate, then get sent to conference, where the tweaking and fixes can best take place. In the meantime, we can’t let opponents get away with mischaracterizing some valid criticisms of the pending legislation.
Monday, July 6, 2009
On the Constitutionality of Health Care
In response to my post on 1 July 2009 (“Can opponents of health care reform explain to me why. . .”), one reader e-mailed me directly several comments, which I would like to share, and to which I would like to respond, in the spirit of perpetuating a dialog on this important issue.
I had asked rhetorically why “health care provided by the government is socialism but national defense isn’t?” to which the reader commented: “Our Constitution provides for national defense; it is silent on healthcare I think”
True, but the question was why a system of health care provided by the government can be criticized for being “socialistic” while national defense provided by the government is not “socialistic.” The obvious reference here is to critics of government-provided health care who condemn it as socialistic, as though to label it as such is a self-explanatory condemnation – disregarding the fact that many services and rights provided at government expense, such as raising and paying for an army, and paying for the medical care of its personnel and dependents, are no less “socialistic.”
I had also asked rhetorically why “the U.S. Postal Service and FedEx can co-exist, but private insurers can’t tolerate a public alternative?” to which the reader suggested that the Constitution is likewise silent on post offices.
Actually, Article I, Section 8, Paragraph 7 gives Congress the right to establish post offices. This is a picky point (I had to look it up myself). The larger issue, and the purpose of my rhetorical question, was to point out to those who criticize a public option for financing health care as being unfair competition for private insurers, that the publically-funded U.S. Postal Service and privately-owned delivery services like FedEx co-exist quite nicely. They do so, however, by serving different segments of the market. The U.S. Postal Service provides a basic level of mail delivery that is available to everyone at relatively low cost. FedEx provides expedited delivery and tracking options for a higher cost, for which some customers in specific circumstances are willing to pay.
I actually think this could be a good model for health care delivery. We the people, through our government, should provide a minimal level of basic health care for everyone, financed from the public treasury (for which we should indeed pay taxes, and which the majority of people polled say they are willing to do, especially if it saves them from the high cost of private insurance). Those who want extra treatment, or elective medical procedures, or special perks added onto their basic level of publically-funded health care can pay private insurers for the privilege.
I had further asked rhetorically why “police and fire protection are a right but health care is a privilege?” to which the reader commented, “ . . . I would argue police and fire protection are services, not rights”
The distinction I was drawing was that those who insist on health care as a profit-making industry implicitly regard it as a privilege, while expecting police and fire protection to be provided by government as a public responsibility, hence a service to which they have a right. Police and fire protection are indeed services (see my post on 15 June 2009), but they are provided by government as needed without regard to what extent an individual is able to pay for them, which implies that we consider them rights available to all citizens. Again, the larger point is, why do we consider some services like police and fire protection to be public responsibilities, while other services like health care (without which the welfare and safety of all citizens is likewise threatened) are not considered public responsibilities?
Another comment made by the reader was “Yes, education can be public, but is anyone truly satisfied with public education?” to which I would respond that, yes, there are some great public school systems doing an excellent job overall of educating our children. And, yes, there are some public schools doing a poor job; but is everyone truly satisfied with the postal service, or the EPA or the CIA? Whether people are satisfied or not with government-funded programs is not the point of this discussion. The point is whether education and the postal service and the EPA and the CIA and a basic level of health care for all Americans should be public rather than private responsibilities.
Finally, in response to my quoting from the Declaration of Independence, in order to document the principles on which our nation was founded, the reader commented that “The only rights we truly have are those enumerated in our Constitution.”
Actually, the 11th Amendment states that “The enumeration in the Constitution of certain rights shall not be construed to deny or disparage others retained by the people.” So the real question is, what constitutes the other rights that ought to be retained by the people collectively? The Constitution does not mandate a Social Security System or NASA or the FBI or the FAA, but we as a people through our elected representatives have declared that we value the services provided by those agencies as legitimate government functions to be paid for by all of us collectively. The question is simply whether access to a basic level of health care should also be one of the collective responsibilities that we share.
I had asked rhetorically why “health care provided by the government is socialism but national defense isn’t?” to which the reader commented: “Our Constitution provides for national defense; it is silent on healthcare I think”
True, but the question was why a system of health care provided by the government can be criticized for being “socialistic” while national defense provided by the government is not “socialistic.” The obvious reference here is to critics of government-provided health care who condemn it as socialistic, as though to label it as such is a self-explanatory condemnation – disregarding the fact that many services and rights provided at government expense, such as raising and paying for an army, and paying for the medical care of its personnel and dependents, are no less “socialistic.”
I had also asked rhetorically why “the U.S. Postal Service and FedEx can co-exist, but private insurers can’t tolerate a public alternative?” to which the reader suggested that the Constitution is likewise silent on post offices.
Actually, Article I, Section 8, Paragraph 7 gives Congress the right to establish post offices. This is a picky point (I had to look it up myself). The larger issue, and the purpose of my rhetorical question, was to point out to those who criticize a public option for financing health care as being unfair competition for private insurers, that the publically-funded U.S. Postal Service and privately-owned delivery services like FedEx co-exist quite nicely. They do so, however, by serving different segments of the market. The U.S. Postal Service provides a basic level of mail delivery that is available to everyone at relatively low cost. FedEx provides expedited delivery and tracking options for a higher cost, for which some customers in specific circumstances are willing to pay.
I actually think this could be a good model for health care delivery. We the people, through our government, should provide a minimal level of basic health care for everyone, financed from the public treasury (for which we should indeed pay taxes, and which the majority of people polled say they are willing to do, especially if it saves them from the high cost of private insurance). Those who want extra treatment, or elective medical procedures, or special perks added onto their basic level of publically-funded health care can pay private insurers for the privilege.
I had further asked rhetorically why “police and fire protection are a right but health care is a privilege?” to which the reader commented, “ . . . I would argue police and fire protection are services, not rights”
The distinction I was drawing was that those who insist on health care as a profit-making industry implicitly regard it as a privilege, while expecting police and fire protection to be provided by government as a public responsibility, hence a service to which they have a right. Police and fire protection are indeed services (see my post on 15 June 2009), but they are provided by government as needed without regard to what extent an individual is able to pay for them, which implies that we consider them rights available to all citizens. Again, the larger point is, why do we consider some services like police and fire protection to be public responsibilities, while other services like health care (without which the welfare and safety of all citizens is likewise threatened) are not considered public responsibilities?
Another comment made by the reader was “Yes, education can be public, but is anyone truly satisfied with public education?” to which I would respond that, yes, there are some great public school systems doing an excellent job overall of educating our children. And, yes, there are some public schools doing a poor job; but is everyone truly satisfied with the postal service, or the EPA or the CIA? Whether people are satisfied or not with government-funded programs is not the point of this discussion. The point is whether education and the postal service and the EPA and the CIA and a basic level of health care for all Americans should be public rather than private responsibilities.
Finally, in response to my quoting from the Declaration of Independence, in order to document the principles on which our nation was founded, the reader commented that “The only rights we truly have are those enumerated in our Constitution.”
Actually, the 11th Amendment states that “The enumeration in the Constitution of certain rights shall not be construed to deny or disparage others retained by the people.” So the real question is, what constitutes the other rights that ought to be retained by the people collectively? The Constitution does not mandate a Social Security System or NASA or the FBI or the FAA, but we as a people through our elected representatives have declared that we value the services provided by those agencies as legitimate government functions to be paid for by all of us collectively. The question is simply whether access to a basic level of health care should also be one of the collective responsibilities that we share.
Wednesday, July 1, 2009
No Wonder They Fear a Public Option
If anyone wonders why health care costs so much in this country, a good place to start looking is the private for-profit health care industry. CEOs at 8 of the nation’s 10 largest health care insurers and providers last year averaged $15.6 million dollars in compensation each.
Those CEOs, their total compensations (salary, plus bonuses, stock options, etc.) and their companies were as follows, according to Forbes:
$30.2M – H. Edward Hanway (CIGNA)
$21.8M – David B. Snow (MEDCO HEALTH)
$20.9M – Dale B. Wolf (COVENTRY HEALTH CARE)
$20.1M – Michael B. McCallister (HUMANA)
$16.7M – Jay M. Gallert (HEALTHNET)
$ 5.8M – Trevor Fetter (TENET HEALTH CARE)
$ 5.2M – Wayne T. Smith (COMMUNITY HEALTH SYSTEMS)
$ 4.0M – Stephen J. Hemsley (UNITED HEALTH GROUP)
Those CEOs, their total compensations (salary, plus bonuses, stock options, etc.) and their companies were as follows, according to Forbes:
$30.2M – H. Edward Hanway (CIGNA)
$21.8M – David B. Snow (MEDCO HEALTH)
$20.9M – Dale B. Wolf (COVENTRY HEALTH CARE)
$20.1M – Michael B. McCallister (HUMANA)
$16.7M – Jay M. Gallert (HEALTHNET)
$ 5.8M – Trevor Fetter (TENET HEALTH CARE)
$ 5.2M – Wayne T. Smith (COMMUNITY HEALTH SYSTEMS)
$ 4.0M – Stephen J. Hemsley (UNITED HEALTH GROUP)
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